South Africa, the country with the highest number of people living with HIV, is facing a severe crisis in its HIV/AIDS response following a significant reduction in U.S. foreign aid. Recent data reveals a steep decline in patient testing and monitoring services, primarily due to the abrupt suspension of funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), which previously played a crucial role in sustaining the nation’s HIV programs.
The aid halt follows Executive Order 14169, signed by U.S. President Donald Trump in early 2025, which ordered a 90-day pause on all U.S. development assistance for review. This sweeping decision has had immediate and disruptive consequences in countries heavily reliant on American health funding, with South Africa among the most affected.
The impact of the funding cuts is already visible across the country. According to South Africa’s National Health Laboratory Service, there has been a more than 20% drop in viral load testing among HIV-positive mothers and infants by April 2025. Many clinics, particularly those operated by NGOs with U.S. backing, have shut down due to financial constraints. As a result, community outreach and essential services have been scaled back drastically, especially in rural and under-resourced areas.
The crisis has also led to the loss of employment for approximately 15,000 health workers who were previously funded by U.S. programs. This has placed additional strain on the remaining healthcare workforce, limiting the capacity to provide testing, counselling, and treatment services. The decline in early diagnosis and ongoing treatment threatens to reverse years of progress in curbing HIV transmission and mortality.
In response, the South African government is urgently seeking alternative funding sources. Health Minister Aaron Motsoaledi has appealed to both local and international foundations to help fill the estimated \$440 million funding gap. The Western Cape provincial government is rolling out contingency measures such as digitizing patient records and providing multi-month antiretroviral prescriptions to maintain continuity of care for stable patients.
International bodies like UNAIDS have also expressed concern over the situation. They have called on the South African private sector to increase support and have proposed the creation of a new Solidarity Fund modeled after the COVID-19 response. The aim is to develop a long-term, locally sustainable funding solution that reduces dependence on foreign aid.
Experts warn that without immediate intervention, the decline in HIV testing and treatment could fuel a resurgence of infections, particularly among young people, pregnant women, and newborns. South Africa’s health infrastructure, already under pressure, may face further deterioration if support is not restored or replaced.
The funding crisis in South Africa highlights the vulnerability of global health initiatives that rely heavily on a single donor. As the country grapples with this emergency, the international community is closely watching to see whether a coordinated response can avert a broader public health setback.